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What Can You Do About Fallen Arches?

Overview

Acquired Flat Feet

There are three types of flat feet: flexible flatfoot, painful rigid flatfoot, and spasmodic flatfoot. Flexible flat feet have some arch, even if the arch only appears while the person is flexing the foot or standing on their toes. Flexible flat feet may not cause pain or require treatment. Painful rigid flatfoot, on the other hand, is abnormal and causes pain, stiffness, and the inability to flex the foot. This often indicates that there is a problem with the bones in the foot, a disease is present, or an injury has occurred. Spasmodic flatfoot involves the foot being forced outward by spasmodic contractions of the peroneal muscle.

Causes

Turning 40 doesn?t necessarily have anything to do with it, but over time you?ve likely engaged in certain activities or developed some unhealthy habits that led to this condition. If you are overweight, you are placing excess burdens on your feet, causing the tendons to strain. Some women experience fallen arches because of weight gain during pregnancy. You also may have damaged these tendons while exercising. If you suffered a serious injury to the foot, you may have weakened the tendons, which can also lead to this development.

Symptoms

Having flat feet can be painless and is actually normal in some people. But others with flat feet experience pain in the heel or arch area, difficulty standing on tiptoe, or have swelling along the inside of the ankle. They may also experience pain after standing for long periods of time or playing sports. Some back problems can also be attributed to flat feet.

Diagnosis

You can always give yourself the ?wet test? described above to see whether you have flat feet. Most people who do not notice their flat feet or have no pain associated with them do not think to see a foot doctor. Flat feet can lead to additional problems such as stiffness or pain, however, especially if the condition appears out of nowhere. If you think you may have flat feet, you should seek medical attention to ensure there are no additional issues to worry about. Your doctor will be able to diagnose you with a number of tests. For example, he or she may have you walk around, stand still, or stand on your tiptoes while you are being examined. Your doctor may also examine your foot?s shape and functionality. It?s important to let your foot doctor know about your medical and family history. In some cases, your doctor may order imaging tests such as x-rays or an MRI (magnetic resonance imaging) to determine a cause of your flat foot. If tarsal coalition is suspected in children, a CT scan is often ordered.

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Non Surgical Treatment

If you have flat feet you may not necessarily need treatment -- sometimes a child or even an adult will have low arches and have no problems. It's normal for a baby's or young child's feet to appear flat until the structure of their feet is more fully developed. If flat feet are contributing to secondary problems, especially leg or foot pain, treatment may be necessary. Flat feet can sometimes cause difficulty walking or running and interfere with athletic activities. A visit to a podiatrist will involve an evaluation of foot structure and function. Besides a foot exam, a visit may include foot X-rays and an analysis of your feet while walking. Your podiatrist may prescribe arch supports or orthotics to control the pronation. While orthotics and arch supports don't permanently correct the shape of the arch, they do help control excess pronation that may be causing wear-and-tear on your muscles and joints. Sneakers with a design called motion control are also helpful for overpronators. This style of sneaker has a design that creates more stability by limiting movement in the heel and arch area of the shoe. Additionally, physical therapy and stretching exercises may be in order, especially if tendonitis (tendon inflammation) is present. Flat feet that are the result of congenital or developmental abnormalities may require further intervention, such as bracing, casting or surgical correction. A brace incorporates an arch support into a device that attaches to the lower leg, giving extra support and flat-foot control. Bracing or foot surgery may also be warranted in cases when flat feet are caused by neurological diseases or are aggravated by posterior tibial tendonitis, which can be a long-term complication of flat feet. Casting is a method used for children whose flat feet are caused by bone positional abnormalities, such as metatarsus adductus. It involves using a series of casts to assist in re-aligning leg and foot bones to their proper anatomical position.

Surgical Treatment

Adult Acquired Flat Feet

Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies. The treatment of a rigid flatfoot depends on its cause. Congenital vertical talus. Your doctor may suggest a trial of serial casting. The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually. However, this generally has a low success rate. Most people ultimately need surgery to correct the problem. Tarsal coalition. Treatment depends on your age, extent of bone fusion and severity of symptoms. For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast. For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot. Lateral subtalar dislocation. The goal is to move the dislocated bone back into place as soon as possible. If there is no open wound, the doctor may push the bone back into proper alignment without making an incision. Anesthesia is usually given before this treatment. Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently. About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

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